PDF(Pubmed)
Abstract：
Background The increase in the incidence of multidrug-resistant (MDR) organisms especially Gram-negative bacteria (GNB) in healthcare facilities is a serious cause of concern. This study identified risk factors for the infection with these MDR GNB, such as Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli to inform healthcare workers about strategies for their containment. Methods A case-control study was carried out at a tertiary care hospital where 100 patients with healthcare-associated infections (infections arising 48 hours after admission) caused by MDR GNB were compared with two control groups, i.e., 100 patients with healthcare-associated infections caused by non-MDR GNB (not meeting the criteria of MDR) and 100 patients without infection caused by GNB. MDR bacteria were defined as the ones that were non-susceptible to at least one antibiotic in three or more classes of antibiotics. The data were analyzed using descriptive statistics (frequency and percentage of categorical variables). Multivariate regression analysis was undertaken to identify significant predictors of MDR GNB. Odds ratios with 95% confidence intervals were calculated, and the level of significance was determined at p-value < 0.05. Results A total of 388 organisms were isolated during four months (January-April 2015) from 332 patients. Fifty-six (17%) of the patients were infected with more than one organism. Among the MDR bacteria, the most dominant MDR organism was A. baumannii (38%), followed by K. pneumoniae (31%), P. aeruginosa (20%), and E. coli (11%). Among the non-MDR organisms, the most dominant was P. aeruginosa (47%), followed by E. coli (32%), K. pneumoniae (18%), and A. baumannii (3%). Patients with MDR organisms compared with the first control group (patients with non-MDR organisms) showed that prior antibiotic use (p-value: 0.001), intensive care unit (ICU) admission (p-value: 0.001), and indwelling medical devices (p-value: 0.005) were significant risk factors for MDR infections. It was also found that the risk factors for MDR GNB infection were the same in the second control group (patients without infection): prior antibiotic use (p-value: 0.002), ICU admission (p-value: 0.001), and indwelling medical devices (p-value: 0.03). Based on the comparison of the two control groups, prolonged hospital stays of more than five days (p-value: 0.001), immunosuppressive therapy (p-value: 0.02), and over 60 years of age (p-value: 0.02) were significant risk factors for non-MDR infection. Conclusion The risk factors identified in our study provide guidance to healthcare workers for the prevention and containment of MDR GNB.
摘要：
背景技术医疗设施中多药耐药(MDR)生物体尤其是革兰氏阴性菌(GNB)的发病率的增加是引起关注的严重原因。这项研究确定了这些MDRGNB感染的危险因素，如鲍曼不动杆菌，肺炎克雷伯菌,铜绿假单胞菌,和大肠杆菌，以告知医护人员有关其遏制策略。方法在三甲医院进行病例对照研究，将100例因MDRGNB引起的医疗保健相关感染（入院后48小时出现感染）的患者与两个对照组进行比较。即，100例由非MDRGNB（不符合MDR标准）引起的医疗保健相关感染患者和100例未由GNB引起的感染患者。MDR细菌被定义为对三种或更多种抗生素中的至少一种抗生素不敏感的细菌。使用描述性统计（分类变量的频率和百分比）分析数据。进行多因素回归分析以确定MDRGNB的重要预测因子。计算95%置信区间的赔率比，并且在p值<0.05时确定显著性水平。结果在4个月内(2015年1-4月)共分离到332例患者中的388株生物。56（17％）的患者感染了一种以上的生物体。在MDR细菌中，最主要的MDR生物是鲍曼不动杆菌(38%)，其次是K。肺炎（31%），铜绿假单胞菌（20%），和大肠杆菌（11%）。在非MDR生物中，最主要的是铜绿假单胞菌（47%），其次是大肠杆菌（32%），K.肺炎(18%)，和鲍曼不动杆菌（3%）。MDR生物体患者与第一对照组（非MDR生物体患者）相比，显示先前使用抗生素（p值：0.001），重症监护病房（ICU）入院（p值：0.001），和留置医疗器械（p值：0.005）是MDR感染的重要危险因素。还发现，在第二对照组（未感染的患者）中，MDRGNB感染的危险因素相同：先前使用过抗生素（p值：0.002），ICU入院（p值：0.001），和留置医疗器械（p值：0.03）。根据两个对照组的比较，住院时间超过五天（p值：0.001），免疫抑制治疗（p值：0.02），60岁以上（p值：0.02）是非MDR感染的重要危险因素。结论本研究确定的危险因素可为医务人员预防和控制MDRGNB提供指导。
